Recover revenue
Specific ICD-10 codes that should have been captured, with PDPM impact, dollar-per-day revenue, and confidence ratings. The dementia code that was missed. The systolic heart failure documented in the physician note but never coded.
PDPM Audit Optimization Group — Powered by RevOptix1
Confidential PDPM record review
See your charts the way an auditor sees them — before an auditor does.
PDPM Audit Optimization Group helps skilled nursing administrators understand what is actually in their documentation, in a confidential engagement built on trust. Powered by RevOptix1, our cross-EMR audit platform.
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PDPM & MDS scoring · live preview
PDPM outputs
MDS 3.0 profile
Primary clinical category
Acute Neurologic
PT groupTO
NTA4 · NF
BIMS13
NursingES3
Why this exists
The average SNF administrator stays in the role for thirty-one months.
That is barely enough time to learn a building before the documentation culture you inherited becomes the documentation culture you are accountable for.
Most administrators sense something is off in their charts long before they can name it. They also know the wrong way to ask the question — too loudly, to the wrong person, in the wrong forum — can end a career.
We exist to give administrators a private mirror. Not a compliance dashboard. Not a vendor scorecard. A real, expert read of your records, delivered to you, in confidence, with the patterns explained in plain language and a path to fix them that does not put you in the line of fire.
The EMR problem
Your EMR does not have to cooperate.
Skilled nursing runs on a patchwork of charting systems — admissions in one, nursing in another, therapy in a third, MDS in a fourth, billing in a fifth. None of them reconcile. All of them are proprietary. And every one was sold to your operator with the promise of audit safety.
When OIG opens your records, none of that matters. They read what is actually there — across every system — and the data lockup your EMR vendors built into their products specifically to prevent third-party review does not protect you. It only delays your visibility into your own facility.
RevOptix1 does not require integration access. It does not require your vendor’s permission. It accepts whatever your EMRs can already produce — PDF exports, CCD documents, HL7 messages, FHIR R4 resources, plain text. It reads across all of them the way an auditor does, finds what does not reconcile, and tells you privately, before someone else asks.
What RevOptix1 delivers
Four things, from a single chart upload.
When you send us a record, we run it through RevOptix1 and return findings in four parts — each one immediately actionable, each one written in the language of the auditors that matter.
Staff training
Tied directly to the chart you uploaded. Not generic compliance education. The MDS coordinator sees exactly what was written and exactly what to write next time, with the CMS-grounded language to use.
Compliance shield
Your audit defense, prepared in advance. For every flagged code, you get the documentation already on file, what needs to be strengthened, and a defense statement written in the language auditors expect. When the ADR letter arrives, you do not write a defense — you already have one.
30-day plan
Specific actions, assigned to specific roles, with timelines. Physician attestations to obtain. MDS sections to update. Wound documentation to complete. Each step shows the revenue impact and the audit risk it closes.
Methodology
The auditors we read for.
Most consultants know one or two auditors well. Usually OIG. Sometimes the RAC. We built RevOptix1 around the methodology of all of them.
OIGPost-payment recoupment behind the Pinnacle case.
RACRecovery Audit Contractor, post-payment claims review.
TPETargeted Probe and Educate, focused chart review.
MAC medical reviewPre- and post-payment review tied to coverage determinations.
UPIC / ZPICProgram integrity contractors, Medicare and Medicaid.
CERTCMS error-rate sampling.
MFCUState Medicaid fraud investigations.
State surveyorsThe deficiency record feeding every other auditor’s data.
RAI / MDS validationCase-mix and assessment accuracy review.
Commercial payer reviewPrivate and Medicare Advantage chart audits.
CMS validationRetrospective review for suspected systemic error.
Internal coding auditsVendor-led proactive and reactive review.
These programs share methods. They share data. They escalate to each other. RevOptix1 reads your records the way all of them read records — at the same time.
How an engagement works
Trust first. Then the chart.
i.
Confidential conversation
We talk before you upload anything. Nothing leaves the room.
ii.
Send us one chart
A single record, in whatever format your EMRs can export.
iii.
Findings, privately
Delivered only to you. Not your operator. Not your board.
iv.
You decide what is next
Single chart. Full audit. Staff training. Or simply space to act.
Tried several consultants before — PDPM Audit Optimization Group’s data analysis and training truly stand out. Insightful, practical, they really know their stuff.
Monica Chandler · Administrator, Long-Term Care
A confidential conversation costs nothing
Send us one chart. See what every one of your systems missed.
OIG has stated that the Pinnacle case is the first in a series. The next facilities sit in the public record, identified by the same signals that put Pinnacle on the list. A single chart, run through RevOptix1, will tell you where you stand.
Message us
Location
Smithfield, Utah
Response time
Most inquiries receive a personal reply within one business day. Active audit response receives same-day attention.